Provider Demographics
NPI:1215283338
Name:VEREEN, CARLISLE MAJOR III (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLISLE
Middle Name:MAJOR
Last Name:VEREEN
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7821
Mailing Address - Country:US
Mailing Address - Phone:843-225-1809
Mailing Address - Fax:843-225-2197
Practice Address - Street 1:2039 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7821
Practice Address - Country:US
Practice Address - Phone:843-225-1809
Practice Address - Fax:843-225-2197
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8109GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$Medicaid